Provider Application

To initiate application to participate as a provider in ProviDRs Care Network, please complete the below application along with attaching the applicable documents listed on the Consent and Release. After completing the initial application, you will be contacted by Medical Provider Resources (MPR) to complete the credentialing process.

All Physician Assistants and Advanced Practice Registered Nurses are also required to complete the collaborative practice agreement. The collaborative practice agreement can be found on the provider homepage located under forms. Completed collaborative practice agreements can be sent to ProviDRs Care via fax, mail, or email.